Doctors, insurers collaborate on care reforms

FORT COLLINS — Her patients – two young sisters – could easily have ended up in the emergency room.

Instead, Dr. Kelly Lowther, a Miramont Family Medicine primary-care physician in Fort Collins, was able to closely monitor their recurring urinary system infections, bring in other professionals in the practice, and prescribe treatments that spared them a trip to the hospital.

“When you have children with medical problems, that’s a pretty stressful and frightening situation,” Lowther said. The mother “was happy that we were intimately involved.”

Restoring a patient’s health is rewarding, of course. But because she was also able to save the insurance carrier money, Lowther also received another sort of reward – a monetary bonus.

This new way of paying doctors has health care reformers excited. They say it’s an approach that has the potential to finally make a real difference in the drive to control health care inflation.

The program “truly has the potential to transform primary care in this country,´ said Dr. David Abbey of Internal Medicine Clinic of Fort Collins.

“If there’s not a solid primary-care foundation for health care delivery in the U.S., we’re not going to have any fix of the health care system,” he added.

Spending time with patients sounds like what doctors are supposed to do. Few, however, seem able to do so. The typical doctor visit in U.S. today lasts just a few minutes, with physicians treating an assembly line of the ill where it might be easy to miss something critical or simply refer a patient to a more costly specialist.

A deeper, more involved level of care was not common before Miramont became one of 17 primary-care practices in the state to participate in a test program that recently ended after three years.

The program helped doctors in primary-care practices find ways to enhance communication among themselves and spend more time with patients, leading to improved care.

The effort also led to an 18-percent decrease in acute inpatient admissions and a 15 percent reduction in total ER visits, according to Anthem Blue Cross and Blue Shield, one of seven insurance companies that participated in the pilot.

In return, the practices received higher reimbursement fees from the insurers.

Physicians said they had to fundamentally change their practices to make it work. That included additional training, hiring new employees and learning new technology.

Because it saw health care costs fall and a rise in healthier patients, Anthem said it planned to expand the program in some Colorado markets later this year. Anthem, a national insurer, also plans to make the program available throughout its primary-care network by the end of 2014.

Anthem said primary-care physicians who participate may earn 30 to 50 percent more than they earn today. By 2015, the program could reduce medical costs by as much as 20 percent.

For the pilot program, local practices received training and guidance from HealthTeamWorks, a Lakewood-based health care consulting company.

In addition to treating patients with ailments such as diabetes or heart disease, the primary-care practices began to spend more energy on the preventative care front. That meant promoting smoking cessation, weight loss and exercise with patients, HealthTeamWorks CEO Dr. Marjie Harbrecht said.

Doctors also focused more on their patients’ past medical problems to pre-empt illnesses from recurring.

At the Internal Medicine Clinic, huddles among staffers became a part of the morning routine. Rather than simply seeing patients, they now review, collaborate and coordinate.

“This little flow of communication can have some big wins as far as patient care,” Abbey said.

Oftentimes, the solutions don’t require advanced medicine.

For example, thanks to one conversation, staffers solved the problem of a patient who could not take regular blood tests because his jobs took him to rural locations without laboratories nearby for extended periods. So they had the patient test himself with a machine and report the results back to the clinic.

ER admissions by Miramont fell by 219 percent below the state average among Medicaid patients.

Bender recently testified before the U.S. House Committee on Ways and Means in a hearing on whether Congress should order Medicare to adopt a similar program.

According to their preliminary data, patients have appreciated the attention, Harbrecht said.

Practices also can spread the workload among staffers, giving patients better access to everyone from receptionists to nurses to doctors.

The team approach also helped relieve doctors of their central role in care, giving other staffers additional input over treatment. In other words, the doctor’s not alone in watching over the patient’s health.

“Patients really feel like they have a relationship with several members of the team,” Harbrecht said.

The program has helped practices find new revenue, as well. Miramont generated more than $100,000 in additional revenue last year, Bender said.

“It’s allowed us to offer more services without having to increase prices, which is a consumer benefit as well,” he said.

All of this should be encouraging news for primary-care practices, which historically have struggled in Larimer County and elsewhere. More than 30 primary-care physicians have abandoned their practice in the past decade; eight of those went bankrupt, Bender said. Meanwhile, the number of ER doctors has increased 50 percent and emergency department beds have doubled.

“What it hopefully will do is bring some cost-containment,” he said. “And for practices that wish to remain independent, give them an economy to do so. But they have to meet the quality standards and they have to be willing to transform their model.”

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